Provider Demographics
NPI:1942513544
Name:AZZAM, BARBARA LOUISE (MED, LPC, CVE, CRC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LOUISE
Last Name:AZZAM
Suffix:
Gender:F
Credentials:MED, LPC, CVE, CRC
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:HUDSON
Other - Last Name:AZZAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC, CVE, CRC
Mailing Address - Street 1:PO BOX 6265
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35813-0265
Mailing Address - Country:US
Mailing Address - Phone:256-895-0008
Mailing Address - Fax:256-325-1668
Practice Address - Street 1:175 CHESTNUT DR STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9527
Practice Address - Country:US
Practice Address - Phone:256-895-0008
Practice Address - Fax:256-325-1668
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL515171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator